Active NPI
Brian R Bergan, DDS
- General Practice Dentistry
- Red Wing, MN
National Provider Identifier
1528082716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11205
- Practice address
- 315 East Ave
Red Wing, MN 55066-2541 - Phone
- (651) 388-1147
- Fax
- (651) 388-1140
- NPI assigned
- Jul 27, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11205 | MN | Primary |
Addresses
Primary practice location
315 East Ave
Red Wing, MN 55066-2541
Mailing address
315 East Ave
Red Wing, MN 55066-2541
Phone (651) 388-1147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Dental Professionals Minnesota PC | Past | Accepting new patients | |
| Brian Bergan Dentistry, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528082716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 EAST AVE",
"city": "RED WING",
"state": "MN",
"postal_code": "550662541",
"telephone_number": "651-388-1147",
"fax_number": "651-388-1140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 EAST AVE",
"city": "RED WING",
"state": "MN",
"postal_code": "550662541",
"telephone_number": "651-388-1147",
"fax_number": "651-388-1140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGAN",
"first_name": "BRIAN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "11205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Wing, MN
- Laurie J Bell
- Benedictine Care Centers (St. Brigid's at Hi-Park)
- Benedictine Care Centers
- Benedictine Care Centers (St. Crispin Living Community - The Villa)
- Jeri Lynn Benser, RN
- Jeremy Scott Berger, D.D.S.
- Sarah Joy Berhow, APRN, CNP
- Marc E Bettich, MD
- Bikes for Everybody LLC
- Bill Clafton PSYD LP LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.